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Fresh cholera threat to Darfur refugees

As monitors warn of an impending crisis in Darfur after cholera arrives from the south, we visit the source of the virus in Sudan's jungle...

There’s a reason why the guards in the truck ahead suddenly switch from relaxing in the sun to loading their Kalashnikovs and scanning the landscape for movement.

A single tree has marked the start of “no man’s land”, a brief but deadly stretch of road joining Uganda to Sudan, and the crossing point of the Lord’s Resistance Army (LRA), the feared rebel group that commonly ambushes vehicles here and executes the passengers.

At least five aid workers travelling along this road have been ambushed and killed by the rebels since October 2005, with others suffering serious injuries.

For aid agencies attempting to curb the spread of deadly cholera in the region it is a risky but essential means of accessing the communities being decimated by this acute diarrhoeal illness.

Figures released last week by the World Health Organisation report 424 deaths in the region since January, with another 14,000 people infected.

On Wednesday the agency confirmed reports it has spread to Darfur, where 2.5m refugees live in squalid conditions and close proximity.

The UN medical authority is warning the epidemic could spread to Sudan’s neighbours, and is urging those sharing its borders to be on high alert.

There have been only isolated cases of cholera south in Uganda, and to the southeast in Kenya, but west, beyond the Democratic Republic of Congo, in Angola, fatalities have reached 1200 since January and 35,000 have been struck by the intestinal infection.

The village of Ikotos, which sits in Sudan’s jungle-like Southern Equatoria state, is the destination for this consignment of treatment packs and fresh water, imported via Uganda by London-based agency World Emergency Relief.

Twice previously the group’s project co-ordinator for Sudan, Matthew Langol, has been airlifted out soon after arriving when rebels ambushed aid convoys travelling behind him .

“It’s very dangerous work,” he admits. “Nobody likes making the journey. But the disease comes in waves here, and no medicine would mean higher fatalities and a chain reaction of transmissions.”

On arrival, he is greeted by Tobiola Alberio, who works with the Ugandan All Nations Christian Care group, part of a network of organisations who work, he says, “like firefighters, trying to catch the sparks before they become infernos”.

In this small village alone there have been 3359 cholera infections and 103 deaths since February. The problem doesn’t stop with the prevention of deaths, Alberio says, as cholera can leave victims practically crippled afterwards.

“In some cases, the sufferer will live after receiving treatment but their land will go unharvested, meaning their families will suffer, or sometimes even die themselves ,” he says.

Survivor Leura Ihiju, 45, has nine children to support, and her husband died in fighting more than a decade ago. She says she was unconscious during her bout of cholera in May. “It came upon me one night and the next day I was critically ill,” she says. “I feel fortunate to be alive, but now I can hardly move”.

Basic medical treatment centres are easily overwhelmed in the area, and just a small outbreak can see patients consigned to the concrete floor of the cholera isolation unit on the village’s outskirts, due to lack of beds.

Many in southern Sudan – which has been wracked by 21 years of civil war – are internally displaced and have little to fall back on when disease strikes.

“Internally displaced refugees have moved sometimes several times, sometimes just small distances, due to LRA violence and every time they must begin again with nothing,” Alberio explains.

They are locked in a cycle of helplessness because Sudan’s Islamic government is ignoring the suffering of the south’s largely Christian population, he says, accusing officials in Khartoum of encouraging their eradication altogether “by funding LRA death squads”.

“It’s why we live in the dark, in huts,” he says. His fellow “black Africans” living further out in the countryside have no clothes, schools, medicines or basic equipment . Sudan’s Arab population in the north is more likely to have clean, running water, electricity and better access to education and health services.

For the international community it is the scale of the spread of cholera in Sudan and Angola that is alarming. “If you compare this to what happened in Angola between 1987 and 1989, there were about 49,000 cases over three years ... now we have had more than 40,000 cases in three months,” says Dr Claire-Lise Chaignat of the WHO’s global task force on cholera control in Geneva.